Julie Miller's Mental Health Blog

Borderline #3

Posted on: February 27, 2010

Treatment for borderline personality disorder is available; I don’t care what other mental health professionals say, it’s treatable and has as good a prognosis as any other mental health issue.

Three primary issues come into play with treatment of borderline personality disorder:  1) medication; 2) therapy; 3) time.

Given that I am not a medical professional, I can’t give anything even remotely like advice on medication issues.  What I have observed is that there are often co-occurring issues with borderline personality, including depression and anxiety.  A competent psychiatric physician (MD or DO) can make an appropriate assessment, diagnosis, and recommendation for medications that might be beneficial.  There is also some research I have read that Omega-3 fish oils (fatty acids) may be beneficial for some of the impulsiveness and other issues.  It’s true – check it out online.

There are a few short-term therapies that purport to help one learn to cope with borderline personality disorder.  DBT (dialectical behavior therapy) was developed at the end of the last century as a means to help anyone learn skills to cope more effectively with the symptoms of borderline personality or issues of similar complexity.  It’s basically a combination of CBT (cognitive behavioral therapy) and mindfulness; it can be very effective.  However, it doesn’t “cure” borderline personality; it increases coping skills.

Is there a cure?  Most mental health professionals would say no; however, there is some significant work based on Freud’s original psychoanalytic work that is designed to heal the attachment wounds that bring borderline personality patterns into being.

This form of therapy goes by a couple names (with small differences in my opinion), including “Object Relations Therapy” and “Self Psychology.”  I have observed this work and have seen its effectiveness in the long-term.  It is not a short-term therapy. A terrific book entitled “Search for the Self,” by James Masterson, MD, is written for the layperson and is very effective in explaining the theory behind this kind of treatment.

In this form of therapy, attachment wounds are healed through the relationship with the therapist.  It is neither an easy nor painless form of healing.  It requires a dogged determination to heal, and persistence, sometimes over a few years.  Not 10 or 15 years, but maybe 3 or 4 (or 5).  This form of treatment requires a highly trained and highly competent therapist.

The training for this kind of therapy is specialized, and not every therapist is interested in developing the skill required.  If you are looking for a therapist to help with borderline personality issues, you will need to find someone who knows what you’re talking about when you say “object relations therapy,” and who can refer you to someone who knows how to do it.  It’s not listed in the yellow pages.

As noted in my blog post entitled “Borderline #2,” borderline personality is sometimes confused with PTSD.  Indeed, if attachment trauma (lack of childhood attachment) underlies any personality disorder, trauma IS borderline personality disorder.  Effectively, then, any form of therapy that will assist with resolving unprocessed traumatic material will be of tremendous assistance in reducing the suffering of an individual with borderline personality disorder.  These forms of treatment include EMDR (eye movement desensitization and reprocessing) and TFCBT (trauma focused cognitive behavioral therapy).

Some say “time heals all wounds.”  Some mental health professionals say borderline personality “burns out” somewhere in middle-age.  Okay, but if you ask me, who wants to wait until they’re 45 or 50 before things get better just with time?  There is also an increased risk of suicide for individuals with borderline personality disorder, so just hanging around, waiting for someone’s borderline personality issues to “burnout” are not a great plan.

Borderline personality disorder is a painful problem.  There is treatment, however, that is effective if provided by well-trained, skills mental health professionals.  Seek competent help.  Ask for referrals.  Research the issues yourself to get more information.  Help is available.

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